关注BNP与NT-proBNP的临床应用

摘要

The precursor of B-type natriuretic peptide (proBNP) is cleaved by a specific enzyme into the biologically active BNP and biologically inactive N-terminal fragment (NT-proBNP).Plasma BNP and NT-proBNP concentrations are affected by gender,age,obesity (higher BMI) and renal function.BNP is primary metabolized by "clearance receptors",NT-proBNP is suggested by renal excretion,so plasma concentrations of NT-proBNP are more affected by renal function than that of BNP.The differential diagnosis of acute dyspnea and acute heart failure (AHF) is one of the most important clinical applications of BNP and NT-proBNP.Two cut-off points were used:a lower one with a high negative predictive value to reliably exclude acute heart failure (AHF) as the cause of acute dyspnoea (rule-out cutoff value),and a second higher one with a high positive predictive value to "rule in" AHF as the cause of dyspnoea (rule-in cutoff value).The rule-in cutoff values of NT-proBNP divided into three levels according to the age,these cutoff values apply irrespective of gender,obesity and renal function,but the rule-in cutoff point of BNP need to be corrected by obesity and renal function.In addition,BNP/NT-proBNP has been shown to provide diagnosis,prognosis and therapy-guiding information in chronic heart failure and coronary heart disease.%急性或慢性心力衰竭的诊断与治疗是具有挑战性的、费用较高的临床问题.B型利钠肽是一种主要由心室细胞分泌的心脏激素,具有促尿钠排泄、舒张血管、舒缓心肌的生物活性.B型利钠肽(包括活性形式BNP与无活性形式N端-proBNP)被证实是诊断或排除急性、慢性心力衰竭高度敏感的标志物.二者的水平与心力衰竭的严重程度具有很强的相关性,并能对患者进行危险分层、预后判断,指导患者治疗.有一些因素影响血浆利钠肽水平,如年龄、性别、肥胖、肾功能,临床应用中需加以考虑.利钠肽对急性冠脉综合征的诊断价值不如传统心肌标志物(肌钙蛋白、肌酸激酶同工酶),但对于患者预后也有很强的预测作用.利钠肽在其他心脏相关疾病中是否也能发挥重要的临床作用值得进一步研究.